The Assessment of Mindfulness with Self-Report Measures:

MINDFULNESS: SELF-REPORT MEASURES

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ORIGINAL PAPER

The Assessment of Mindfulness with Self-Report Measures: Existing Scales and Open

Issues

Claudia Bergomi•Wolfgang Tschacher•Zeno Kupper

___________________________

C. Bergomi •W. Tschacher •Z. Kupper

University Hospital of Psychiatry, Department of Psychotherapy, University of Bern,

Laupenstrasse 49, CH-3010 Bern,

E-mail: [email protected]

This is an Author's Original Manuscript of an article submitted for consideration

in Mindfulness [copyright Springer]; the final publication is available online at

www.springerlink.com: http://dx.doi.org/10.1007/s12671-012-0110-9


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Abstract

During recent years, mindfulness-based approaches have been gaining relevance for treatment

in clinical populations. Correspondingly, the empirical study of mindfulness has steadily grown, thus

the availability of valid measures of the construct is critically important. This paper gives an overview

of the current status in the field of self-report assessment of mindfulness. All eight currently available

and validated mindfulness scales (for adults) areevaluated, with a particular focus on their virtues and

limitations and on differences among them. It will be argued that none of these scales may be a fully

adequate measure of mindfulness, as each of them offers unique advantages but alsodisadvantages. In

particular, none of them seems to provide a comprehensive assessment of all aspects of mindfulness

in samples from the general population. Moreover, some scales may be particularly indicated in

investigations focusing on specific populations such as clinical samples (CAMS, SMQ) or meditators

(FMI).Three main open issues are discussed: 1) the coverage of aspects of mindfulness in

questionnaires, 2) the nature of the relationships between these aspects and 3) the validity of self-

report measures of mindfulness. These issues should be considered in future developments in the self-

report assessment of mindfulness.

Keywords: Mindfulness; Assessment; Self-Report; Questionnaire


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Introduction

During the last decades, the empirical study of mindfulness and the use of mindfulness

techniques in clinical practice have been steadily expanding. The efficacy of mindfulness-oriented

interventions such as Mindfulness-Based Stress Reduction (MBSR; Kabat-Zinn, 1990) and

Mindfulness-Based Cognitive Therapy (MBCT; Segal, Williams & Teasdale, 2002; Teasdale, Segal &

Williams, 1995) has been established (Grossman, Niemann, Schmidt & Walach, 2004; Hofmann,

Sawyer, Witt & Oh, 2010; Shigaki, Glass & Schopp, 2006). Currently, researchers increasingly

concentrate on the mechanisms through which mindfulness exerts positive influences on mental and

physical well-being (Coffey & Hartman, 2008; Crane, Barnhofer, Hargus, Winder & Amarasinghe,

2010; Shapiro, Carlson, Astin & Freedman, 2006; Williams, McManus, Muse & Williams, 2011).

A reliable and valid measurement of mindfulness is crucial for empirical investigation,

especially as research is moving increasingly toward the study of how mindfulness influences health.

The present article provides an overview and discussion of the state of assessment of mindfulness

using self-reports. As reliability and validity analyses of current scales were already extensively

covered elsewhere (Baer, Walsh & Lykins, 2009; Johnson, 2007), we will focus on conceptual issues

related to the content of the available self-report measures (content validity), on the relative strengths

and disadvantages of each scale as well as on the interpretation of unexpected findings and their

implications for the validity of the assessment of mindfulness. First, general issues regarding the

definition and operationalization of mindfulness will be described. We will then give a critical

overview of the currently available validated self-report measures of mindfulness. Finally, we will

highlight implications and future challenges for the conceptualization and operationalization of

mindfulness.

The Search for a Consensual Definition and Operationalization of Mindfulness

Bishop and colleagues (2004) offered an influential suggestion for a consensual definition and

operationalization of mindfulness. The authors described two components of mindfulness: 1) self-

regulation of attention such that it is directed to the present moment, 2) a particular orientation

involving curiosity, openness and acceptance. If one considers other definitions proposed in the

scientific literature, further aspects might be added to the second component, mindful orientation.


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These aspects are: a non-judgmental, compassionate and openhearted attitude, non-identification with

the experiences, insightful understanding, non-reactivity to the experiences, a decentered stance (i.e.

experiencing one’s thoughts and feelings from a decentered perspective, without over-identifying with

them) and participation in the experience (Brown & Ryan, 2004; Kabat-Zinn, 1994, 2003; Lau et al.,

2006;Marlatt & Kristeller, 1999;Robins, 2002; Teasdale et al., 2002; Walach, Buchheld, Buttenmüller,

Kleinknecht & Schmidt, 2006). Hence, mindfulness can be conceptualized as a form of attention

characterized by a range of attributes or aspects, which are distinct but overlapping (e.g. acceptance

and non-judgment). The breadth and complexity of mindfulness, as well as its origins in Buddhist

psychology, have significantly contributed to the current plurality of definitions and

operationalizations. As a result, over the last decade at least eight mindfulness self-report

questionnaires have been developed and are now employed in psychological research: The Freiburg

Mindfulness Inventory (FMI; Buchheld, Grossman & Walach, 2001; Walach et al., 2006), the Mindful

Attention Awareness Scale (MAAS; Brown & Ryan, 2003), the Cognitive and Affective Mindfulness

Scale-Revised (CAMS-R; Feldman, Hayes, Kumar, Greeson & Laurenceau, 2007; Hayes & Feldman,

2004), the Southampton Mindfulness Questionnaire (SMQ; Chadwick et al., 2008), the Kentucky

Inventory of Mindfulness Scale (KIMS; Baer, Smith & Allen, 2004), the Five Facet Mindfulness

Questionnaire (FFMQ; Baer, Smith, Hopkins, Krietenmeyer & Toney, 2006), the Philadelphia

Mindfulness Scale (PHLMS; Cardaciotto, Herbert, Forman, Moitra & Farrow, 2008) and the Toronto

Mindfulness Scale (TMS; Lau et al., 2006).

The availability of a variety of measures of mindfulness can be beneficial for research. For

instance, the TMS specifically assesses the capacity to invoke a mindfulness state during meditation

practice, whereas at least seven scales (FMI, MAAS, CAMS-R, MQ, KIMS, FFMQ, and PHLMS)

were designed to measure trait mindfulness. The theoretical and operational distinction between state

and trait mindfulness is appropriate, as both are closely related but different constructs (Thompson &

Waltz, 2007). In fact, studies suggest that there is little or no relationship between the mindfulness

state during meditation (TMS) and everyday trait mindfulness (FFMQ, CAMS-R, and MAAS;

Carmody, Reed, Kristeller & Merriam, 2008; Thompson & Waltz, 2007). It is thus advisable to have

at one’s disposaldistinct questionnaires capturing either trait or state mindfulness.


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Current mindfulness scales differ with respect to fundamental aspects of the mindfulness

construct. While most scales include a focus on attention or awareness, comparisons also reveal

substantial deviations. For instance, the MAAS (Brown & Ryan, 2003) measures mindfulness rather

narrowly, focusing on the attention component. The KIMS and the FMI measure mindfulness as a

multifaceted construct. However, the facets are distinct in the KIMS (Baer et al., 2004) but overlap in

the FMI and cannot be clearly distinguished through factor analysis (Leigh, Bowen & Marlatt, 2005;

Walach et al., 2006). Accordingly, correlations of mindfulness measurements between MAAS,

CAMS, FMI, KIMS and PHLMS were found to range from .21 to .67 (Baer et al., 2006; Cardaciotto

et al., 2008). This heterogeneity in the self-report assessments of mindfulness evidently constitutes a

problem for comparing and replicating research findings.According to a recent study, current

mindfulness scales include nine distinguishable aspects of mindfulness whereas each scale comprises

a different subset of these aspects and none includes all (Table 1) (Bergomi, Tschacher & Kupper, in

press).The nine aspects were theoretically derived based on a review of eight questionnaires, the

subscales they include, and the theoretical constructs their conceptualization is based upon. All

aspects of mindfulness included in the scales were listed and semantically grouped, taking into

consideration the scale descriptions and the content of items. The resulting aspects are (1) observing,

attending to experiences, (2) acting with awareness, (3) non-judgment, acceptance of experiences, (4)

self-acceptance, (5) willingness and readiness to expose oneself to experiences, non-avoidance, (6)

non-reactivity to experience, (7) non-identification with own experiences, (8) insightful

understanding, and (9) labeling, describing.

The subsequent section will provide an overview of the existing validated mindfulness scales

(for adults), of their strengths and limitations as well as of relevant research findings. Particular

attention will be paid to the conceptualization of mindfulness underlying the scales and their

suitability for assessing mindfulness in the general population. All scales presented in the following

show satisfactory to good internal consistency; several studies have supported their convergent,

discriminant and known-groups validity (Baer, Walsh & Lykins, 2009; Johnson, 2007). Evidence for

their predictive validity is nevertheless still scarce and, to our knowledge, limited to the MAAS: in

one study posttreatment MAAS scores predicted the risk of relapse/recurrence to major depressive


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disorder during 12 months after an MBCT intervention (Michalak, Heidenreich, Meibert & Schulte,

2008). Moreover, scores of mindfulness questionnaires show inconsistent patterns of relationship with

practice in meditators. Studies provided evidence for positive associations of meditation practice with

MAAS, KIMS, FMI, FFMQ, and TMS (Baer et al., 2004, 2006, 2008; Brown & Ryan, 2003; Walach

et al., 2006) as well as for the absence of such relationships with MAAS, FFMQ, CAMS, MQ, and

TMS (Baer et al., 2006, 2008; Carmody et al. 2008; Lau et al. 2006; MacKillop & Anderson 2007).It

is not the primary focus of the present overview to systematically reinvestigate this psychometric

evidence. Issues relating to the validity of the scales will be addressed insofar as they may contribute

to guide the construction of further mindfulness scales.

This overview will start with two questionnaires, the FMI and the TMQ, which require

respondents have some meditation experience. The remaining questionnaires, which should allow

measurement of mindfulness in individuals without meditation experience, will be reviewed in an

order convenient for the logic of the argumentation in the overview.

Overview of Available Mindfulness Scales

The Freiburg Mindfulness Inventory (Buchheld et al., 2001; Walach et al., 2006)

The construction of the Freiburg Mindfulness Inventory (FMI) was particularly inspired by

the Buddhist roots of the construct. Items construction and selection were based on an extensive

review of mindfulness and insight meditation literature, interviews with experts (i.e. mindfulness

meditation teachers and long-time meditators) and, finally, on validation analysis in a sample of

Buddhist meditators. The final scale contains 30 items. The four-factor structure found in the

validation study (mindful presence, non-judgmental acceptance, openness to experiences and insight)

was found to be unstable (Walach et al., 2006). Correspondingly, in two studies principal

componentanalyses yielded a three-factor (Leigh et al., 2005) and a four-factor (Bergomi, 2007)

structure differing from the structure of the FMI validation study, thus reflecting the richness of

aspects of mindfulness captured by this scale. In the FMI, mindfulness comprises facets that cannot be

clearly disentangled. Further statistical analyses led to a short, putatively one-dimensional 14-item

version of the FMI that should be more appropriate for use in the general population (Walach et al.,

2006). In two studies, the 14-item version was found to be two-dimensional, comprising a presence


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factor (FMI 7: “I feel connected to my experience in the here-and-now.”) and an acceptance factor

(FMI 9:“I am friendly to myself when things go wrong.”), with the number of items of each subscale

differing between studies (Kohls, Sauer & Walach, 2009; Ströhle, 2006). A recent qualitative analysis

of the German (i.e. original) 14-item FMI showed that individuals without meditation experience

systematically misunderstood items 1 (“I am open to the experience of the present moment”), 2 (“I

sense my body, whether eating, cooking, cleaning or talking.”), 3 (“When I notice an absence of mind,

I gently return to the experience of the here and now.”), and 7 (see above) (Belzer, Schmidt & Lucius-

Höhne, 2011). The authors recommended reformulating these items.

In summary, the FMI in its current (short and long) versions, seems inappropriate in

populations unfamiliar with mindfulness or Buddhist concepts, since at least some items may be

systematically misunderstood by individuals without meditation experience. Nevertheless, the FMI

may be particularly suited for addressing aspects of mindfulness that are relevant to experienced

meditators and its use is encouraged in populations familiar with meditation. As the scale comprises

more ‘advanced’ items it may better differentiate among meditators. The unstable factor structure of

the FMI does not allow the measurement of distinct facets of the mindfulness construct. This is an

important limitation for the analysis of the differential contributions of each aspect of mindfulness and

of their association with other constructs (Smith, Fischer & Fister, 2003; Smith & McCarthy, 1995).

However, the lack of a clear-cut structure found in the FMI is possibly less an indication of weakness

of the scale rather than an inherent aspect of mindfulness itself. This issue will be discussed further.

The Toronto Mindfulness Scale (Lau et al., 2006)

The Toronto Mindfulness Scale (TMS) was developed by Lau and colleagues (2006) as a

measure of the mindful state. The scale addresses a person's experiences during an immediately

preceding meditation session. The TMS comprises two factors, curiosity (TMS 17: “I was curious

about my reactions to things”) and decentering (TMS 33: “I was more concerned with being open to

my experiences than controlling or changing them”). A trait version of the TMS was developed and

preliminarily validated in meditators and nonmeditators (Davis, Lau & Cairns, 2009). Both trait

decentering and traitcuriosity were positively associated with other trait mindfulness scales, with

correlations higher for trait decentering. The trait decentering scores were higher in participants with


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longer meditation experience. Similarly, in the validation study of the state version of the TMS state

decentering was generally higher in meditators with more meditation experience, whereas state

curiosity was increased only in a subgroup of meditators trained in mindfulness meditation as

described in MBSR, yet not in the Shambhala subgroup. These results suggest that the curiosity

subscale of the TMS may be specific to particular conceptualizations of mindfulness. The Shambhala

Buddhist tradition emphasizes the redirection of attention to the meditation object rather than the

observation and investigation of distracting experiences (as is emphasized in the non-secular practice

of MBSR), which may explain the reported lack of effect of this practice on curiosity (Lau et al.,

2006). Moreover, the Shambhala tradition focuses on existing in the world as a ‘warrior’ who is

seeking enlightenment out of compassion for all sentient beings (Rinpoche, 2005). In contrast, all

curiosity items of the TMS are directed towards oneself (TMS 32: “I was curious about what I might

learn about myself by taking notice of how I react to certain thoughts, feelings or sensations.”).

In sum, the TMS measures two aspects of mindfulness: decentering and curiosity. Thus the

TMS has the advantage of explicitly assessing the decentered stance to experiences which, as a central

aspect of mindful attention (Teasdale et al., 2002), is clearly underrepresented among current

mindfulness scales. Moreover, the TMS is the only current mindfulness scale assessing state

mindfulness. The TMS seems to focus on the second component of mindfulness (mindful orientation)

proposed by Bishop and colleagues (2004), whereas self-regulation of attention is not explicitly

measured by this scale. Results from meditator subgroupssuggest that the curiosity subscale of the

TMS may be more related to specific conceptualizations of mindfulness, for example mindfulness as

taught in MBSR, rather than to a more general mindfulness construct.

The Philadelphia Mindfulness Scale (Cardaciotto et al., 2008)

The Philadelphia Mindfulness Scale (PHLMS) is a 20-item questionnaire comprising two

subscales: awareness and acceptance. The awareness subscale assesses noticing and being aware of

thoughts, feelings, perceptions and body sensations (PHLMS 3: “When talking with other people, I

am aware of their facial and body expressions.”) while the acceptance subscale is focused on the

assessment of experiential avoidance (PHLMS 12: “There are things I try not to think about.”). The

scale is theoretically well-founded, predominantly based on definitions of mindfulness proposed by


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Kabat-Zinn (1994) and Bishop and colleagues (2004). Unfortunately, the two components of the

PHLMS are conceptualized rather narrowly. The awareness subscale comprises open awareness of

perceptions, sensations and feelings and omits the acting with awareness aspect that is covered, for

example, in the KIMS or FFMQ (Baer et al., 2006). Moreover, the acceptance subscale contains only

items that are negatively formulated and capture experiential avoidance while positive acceptance, a

compassionate stance towards oneself, non-reactivity and non-judgment are excluded.

The Mindful Attention Awareness Scale (Brown & Ryan, 2003)

The Mindful Attention Awareness Scale (MAAS) is a 15-item scale measuring mindfulness as

a single factor relating to attention. The one-dimensional structure of the MAAS was replicated in

several studies (Carlson & Brown, 2005; MacKillop & Anderson, 2007). Originally, the MAAS

comprised a presence and an acceptance factor. The acceptance factor was excluded in the final

version because it did not provide an “explanatory advantage over that shown by the presence factor

alone” (Brown & Ryan, 2004, p. 244). The authors concluded that the acceptance of the present

moment is already embedded within the capacity for sustained attention and thus “as a distinct

construct, acceptance is functionally redundant in mindfulness” (Brown & Ryan, 2004, p. 245). This

conclusion, however, is challenged by results obtained with the PHLMS, which comprises both

awareness and acceptance subscales. The associations reported in the validation study of the PHLMS

suggest an explanatory advantage of the acceptance factor over the awareness factor, as the former

was markedly associated with indicators of well-being that were uncorrelated to awareness. Similarly,

using the 14-item FMI, Kohl, Sauer, and Walach (2008) claimed that the negative relationship

between mindfulness and anxiety and depression may be “completely due to the “Acceptance” factor

of mindfulness” (p. 224).

One important difference between the MAAS and both PHLMS and FMI is that the

awareness items in the PHLMS and the 14-item-FMI are all in the positive form, whereas in the

MAAS items are all negatively formulated (MAAS 7: “It seems I am “running on automatic” without

much awareness of what I’m doing.”). Some authors have described the MAAS as a measure of

“being seriously ,spaced out’” (Rosch, 2007, p. 262-3), an agitated lack of attentiveness (Grossman,

2008), everyday attention lapses (Carriere, Cheyene & Smilek, 2008) or automatic pilot and its effects


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(Williams, 2010). The negative formulation of the MAAS may implicitly measure a judgmental and

critical stance towards oneself. This assumption is supported by several findings. First, the MAAS has

a higher correlation with the acceptance subscale than with the subscale capturing an open observing

stance of the PHLMS (r = .32 vs. .21, p < .001; Cardaciotto et al., 2008) and of the KIMS (r = .41 vs.

.18, p < .01; Höfling, Moosbrugger, Schermelleh-Engel & Heidenreich, 2011). Second, in the

validation study of the Child and Adolescent Mindfulness Measure (CAMM; Greco, Baer & Smith,

2011) items reflecting 1) noticing or attending to internal phenomena, 2) lack of awareness of ongoing

activities (i.e. similar to the presence items of the MAAS) and 3) a judgmental, non-accepting stance

towards thoughts and feelings were subjected to exploratory factor analysis. In the resulting two-

factor solution of the CAMM, the MAAS-similar items and those capturing a judgmental stance

loaded on the same factor, supporting semantic relatedness. In other words, the presence factor of the

MAAS may include an acceptance aspect and thus an additional acceptance factor loses explanatory

power. This appears to be a result of the specific formulation of the presence items in the MAAS.

In summary, the MAAS allows a concise assessment of mindfulness in populations without

previous meditation experience. This scale appears to address both the attention and the acceptance

aspects of mindfulness, yet does not differentiate one aspect from the other. Moreover, measuring

mindfulness 'negatively' may not reflect the complete spectrum of mindfulness experiences.

The Cognitive and Affective Mindfulness Scale-Revised (Feldman et al., 2007; Hayes &

Feldman, 2004)

The Cognitive and Affective Mindfulness Scale-Revised (CAMS-R) is a 12-item scale of

mindfulness in general daily experience. The scale was designed to address attention, present-focus,

awareness and acceptance/non-judgment of thoughts and feelings, which all converge in a single total

mindfulness score. The scale differs in an interesting way from most other mindfulness scales: most

items capture a capacity and willingness to be mindful (CAMS-R 9: “I try to notice my thoughts

without judging them,”; CAMS-R 1: “It is easy for me to concentrate on what I am doing”) rather

than the extent to which an individual is being mindful throughout the day. Moreover, in developing

the CAMS, the authors' intention was to measure “a kind of mindfulness that … could be useful in the

treatment of depression” (Hayes & Feldman, 2004, p. 260). Correspondingly, the present-focus items


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of the CAMS involve a tendency to preoccupation or worrying (CAMS-R 2: “I am preoccupied by the

future”). In two studies, the CAMS-R (resp. the CAMS) was more related to measures of

psychological distress (e.g. psychological symptoms, neuroticism, difficulties in emotion regulation)

than the MAAS, FMI, KIMS, and SMQ (Baer et al., 2006; Thompson & Waltz, 2007). In sum, the

CAMS-R offers a short instrument that still captures different aspects of mindfulness. Mindfulness as

measured by the CAMS-R is unique in two ways: 1) it is understood as the willingness and ability to

be mindful rather than as a realization of mindfulness experience during the day, and 2) it is

particularly related to psychological distress. As a consequence, the CAMS-R may be of particular use

in clinical studies.

The Southampton Mindfulness Questionnaire (Chadwick et al., 2008)

The Southampton Mindfulness Questionnaire (SMQ; first introduced as Mindfulness

Questionnaire, MQ, Chadwick et al. 2005, in Baer et al. 2006) is a 16-item scale with four related

bipolar aspects of a mindful approach to distressing thoughts and images. All items begin with,

“Usually, when I have distressing thoughts or images” and continue with a mindfulness-related

response (SMQ 1: “I am able to just notice them without reacting.”; SMQ 12: “In my mind I try to

push them away”). The four bipolar aspects assessed by the SMQ are 1) decentered awareness vs.

being lost in reacting to cognitions; 2) allowing attention to stay in contact with difficult cognitions

vs. experiential avoidance; 3) acceptance of difficult thoughts and images and of oneself vs. being

judgmental; 4) letting go of and being non-reactive to difficult cognitions vs. rumination or worry.

Exploratory factor analyses, however, suggested a one-dimensional factor structure of the scale

(Chadwick et al., 2005; 2008). The SMQ specifically assesses how (mindfully) one relates to

“distressing thoughts and images, which are important phenomena in all mental health problems and

the cornerstone of cognitive theory and therapy” (Chadwick et al., 2008, p. 452). Hence, the SMQ

may prove to be very useful for the investigation of relationships between mental health problems and

mindful awareness. The scale appears particularly suited for studies focusing on the effects of a

mindful attitude towards distressing inner experiences but may be too specific for more general use,

as it does not involve items relating to positive or neutral phenomena. Moreover, individuals who are

less prone to distressing thoughts and images may have difficulties relating the SMQ items to their


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daily experience.

The Kentucky Inventory of Mindfulness Scale (Baer, Smith & Allen, 2004)

The Kentucky Inventory of Mindfulness Scale (KIMS) comprises 39 items that largely target

the conceptualization of mindfulness skills as described in Dialectical Behavioral Therapy (DBT;

Linehan, 1993). The KIMS was designed to measure four aspects of mindfulness in daily life

(observing, describing, acting with awareness and accepting without judgment). One aspect of

mindfulness unique to the KIMS and largely based on elements of DBT is describing, the ability to

verbally describe (or label) experiences (KIMS 10: “I’m good at thinking of words to express my

perceptions, such as how things taste, smell, or sound.”). In the mindfulness tradition, labeling of

experiencesis often considered a component of mindfulness meditation, signifying a general

recognition that thoughts are (just) thoughts, feelings are feelings, etc. rather than an accurate

description of feelings or of the contents of thought. In fact, mindfulness has been described as being

pre- or para-conceptual, not involving categorization, reflection, introspection or comparisons of

experiences (Brown et al., 2007; Gunaratana, 2002). It is thus unclear to what extent the ability to

verbally describe experiences as measured by the KIMS constitutes a core component of mindfulness

and should accordingly be a central facet in a mindfulness scale. In 2006, Baer and colleagues

developed a further self-report measure of mindfulness, the FFMQ, which includes the four facets of

the KIMS and many of its items. As these two scales are similar and interrelated, they will be

discussed jointly in the following section.

The Five Facet Mindfulness Questionnaire (Baer et al., 2006)

The Five Facet Mindfulness Questionnaire (FFMQ) is a 39-item multifaceted scale covering

five aspects of mindfulness: nonreactivity to inner experience (nonreact),

observing/noticing/attending to sensations/perceptions/thoughts/feelings (observe), acting with

awareness/automatic pilot/concentration/nondistraction (actaware), describing/labeling with words

(describe) and nonjudging of experience (nonjudge). We will describe the FFMQ in more detail, as it

constitutes an important attempt to integrate the conceptualizations and operationalizations of five

validated mindfulness questionnaires. This scale and its facets resulted from an exploratory factor

analysis of the combined pool of 112 items collected from the KIMS, the FMI, the MAAS, the


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CAMS, and the SMQ. The factor analysis produced five factors that could be replicated with

confirmatory factor analysis (Baer et al., 2006). In a hierarchical model all facets except observe

(KIMS 21: “I pay attention to sensations, such as the wind in my hair or sun on my face.”) were

shown to be aspects of an overall mindfulness construct (in a subgroup of meditators, observe

significantly loaded on the overall mindfulness construct as well). This finding was unexpected, since

observing, i.e. directing attention at perceptions and experiences, is generally recognized as the core

aspect of mindfulness. Moreover, the observe facet was unexpectedly positively correlated with

measures of dissociation, absent-mindedness, psychological symptoms and thought suppression, and

not associated with nonjudging of experience (Baer et al., 2006). Furthermore, the nearly identical

observe scale of the KIMS (which comprises some additional items) was negatively associated with

the accepting without judgment KIMS scale in a college student sample (Baer et al., 2004). Similar

associations with thought suppression (Greco, Baer & Smith, 2011; Thompson & Waltz, 2010),

somatic complaints (Greco, Baer & Smith, 2011), and accepting without judgment (Vujanovic,

Youngwirth, Johnson & Zvolensky, 2009) were also established in further studies using the original

English versions of the FFMQ and KIMS and in the validation study of the CAMM (an adaptation of

the KIMS for children and adolescents, from which the Observing scale was finally excluded). The

authors proposed that attention to experiences might be related to a tendency towards judging them in

individuals without meditation experience, which is not (or less so) the case for people with

meditation experience. In accordance with this, the correlation between the FFMQ observe and the

FFMQ nonjudging of experience was positive in a subgroup with meditation experience (Baer et al.,

2006). However, other mindfulness scales do not show similar association patterns (Bergomi, 2007;

Cardaciotto et al., 2007). These unexpected patterns may be more related to the observe items of the

FFMQ than to the attending to experience that is characteristic of mindfulness. Baer et al. (2006)

proposed that the unexpected results may be due to FFMQ observe items addressing external stimuli

and bodily sensations, whereas items pertaining to other facets are rather related to internal factors

such as emotions, cognitions and functioning on ’automatic pilot’ (Baer et al., 2006). However, this

explanation leaves the unexpected positive associations between observe items and measures of

mental disorders unresolved. One possible alternative explanation is that many items of the observe


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facet involve aspects such as strain and effort to pay attention (KIMS 9: “When I’m walking, I

deliberately notice the sensations of my body moving.”; KIMS 13: “When I take a shower or a bath, I

stay alert to the sensations of water on my body.”). What these items aim at may be well understood

by individuals with some degree of meditation experience, but in the general population, endorsement

of such items may reflect an exaggerated tendency to self-attention. Moreover, individuals lacking

experience with meditation may easily misinterpret and misunderstand FFMQ items such as “I notice

how foods and drinks affect my thoughts, bodily sensations, and emotions.” (KIMS 17) (cf.

Grossman, 2008).

In sum, the FFMQ is a comprehensive scale that integrates the conceptualizations of

mindfulness underlying five validated mindfulness scales and measures clearly distinct facets of

mindfulness. It is thus a suitable instrument for the assessment of differential contributions of

mindfulness aspects. Unfortunately, it also has several limitations. The approach leading to the scale

was mainly empirically (rather than theoretically) founded. Merging all items of different mindfulness

scales produced a rather arbitrary item pool, in which some theoretically meaningful aspects of

mindfulness are absent (e.g. willingness and readiness to expose oneself to experiences), whereas

others are over- or underrepresented. Additionally, it must be expected that those questionnaires which

contributed more items to the item pool and which had a clearer factor structure may have had a larger

impact on the results of the exploratory factor analysis. In particular, four out of the five facets

resulting from the analysis yielded the same factor structure as the KIMS, which was the longest scale

included in the analysis and the only one showing a clear multifaceted factor structure. It may be a

consequence of this procedure that some of the aspects present in the five contributing questionnaires

did not appear in the final factor structure of the FFMQ. For example, non-identification with own

experiences,which is included in the FMI and the SMQ,failed to emerge from the factor analysis.The

observe facet was positively associated with psychopathological categories and with mental disorders

and, in a hierarchical model, it failed to load on an overall (second-order) mindfulness factor (Baer et

al., 2006). It is thus unclear whether the observe items adequately pertain to the quality of noticing, an

essential characteristic of mindfulness.

Implications for the Assessment of Mindfulness


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The available questionnaires provide an interesting range of instruments, some of which may

be particularly helpful in the investigation of specific research questions. For example, the CAMS and

the SMQ may be preferable for assessments in clinical practice and research, as they focus on

clinically relevant aspects such as reactions on distressing inner experiences. All other scales may also

be applied in clinical contexts but may be more generally useful for research, including fields such as

meditation research, cognitive science, and social psychology. For example, the use of the FMI may

be encouraged in populations that are familiar with meditation. For assessments in the general

population, the FFMQ provides the most comprehensive coverage of aspects of mindfulness, whereas

the PHLMS offers the advantages of a short but multi-dimensional scale.

Yet, the current situation in the self-report assessment of mindfulness suffers from several

limitations. First, each of the validated mindfulness scales is associated with particular advantages but

also disadvantages for a comprehensive assessment of mindfulness in the general population. Second,

substantial differences in the covered aspects of mindfulness hinder the comparison of results from

studies using different scales, thus impeding communication about the construct (Brown et al., 2007;

Malinowski, 2008). Finally, results from current scales point at a possible further problem: the

inclusion of items that can be easily misinterpreted, in particular by respondents who are not familiar

with the mindfulness concept (cf. Grossman, 2008).

The availability of a suitable scale, however, is essential for research in the rapidly evolving

field of mindfulness research. New self-report instruments may therefore be needed that are

theoretically based and take into account previous operationalizations as well as results from the

empirical research based on the available measures. The development of new scales may profit from

cross-validation with constructs that are closely related to mindfulness such as nonattachment

(Sahdra, Shaver & Brown, 2010), self-compassion (Neff, 2003) and awareness (Shields, Mallory,

Simon, 1989), as well as with mindfulness measures that do not rely on self-report but, for example,

on experimental tasks or interview data (Grossman, 2008; Frewen, Lundberg, MacKinley & Wrath,

2011). The development of such measures is attracting increasing interest (see Bishop et al., 2004;

Brown & Ryan, 2003; Burg & Michalak, 2010; Collins et al., 2009; Davidson, 2010; Dobkin, 2008;

Frewen, Evans, Maraj, Dozois & Partridge, 2008; Williams, 2010).


16

Open Issues for Self-Report Measures

Researchers working on the further development of self-report measures of mindfulness will

have to deal with at least three major open issues: 1) the aspects of mindfulness to be assessed, 2) the

nature of the relationships between these aspects, and 3) the validity of mindfulness assessment using

self-report. In the following, these issues and possible research strategies for resolving them will be

described.

The issue of the coverage of the aspects of mindfulness is related to the comprehensiveness

or, conversely, the parsimony (Carmody, 2009) of assessments. As mentioned above, each of the

current mindfulness scales provides a different description of the construct (Christopher, Charoensuk,

Gilbert, Neary & Pearce, 2009). Conceiving of mindfulness too narrowly would entail the danger of

denaturizing the construct, e.g., by focusing primarily on the attention component while leaving out

the attributes that distinguish mindfulness from a more general attention construct. For

operationalizations of mindfulness this would correspond to a lack of content validity. On the other

hand, Eleanor Rosch (2007) suggested that some of the factors included in current mindfulness

questionnaires assess traits indicating reasonableness such as not being “spaced out”, overly

emotional, or self-critical. This may imply that a more general inclusion of such aspects may lead to

“measuring a construct of more versus less pathology … or Relative Sanity or Reasonableness’’

(Rosch, 2007, p. 262-3). There is no definite answer to the issue of conceptual coverage of

mindfulness because no normative mindfulness definition exists. Despite disparities, the

conceptualizations of mindfulness behind current questionnaires also show important similarities and

overlaps pointing to an implicit consensus among experts regarding an applicable definition of

mindfulness for scientific research. It seems reasonable for research to pursue a flexible (but still

consensual) conceptualization of the construct. In our view, the use of a more comprehensive

conceptualization and operationalization of mindfulness is preferable. Our exploratory study based on

the nine aspects of mindfulness reported in Table 1 pointed, on one side, to the relevance of non-

avoidance as an aspect of the mindfulness construct and, on the other side, to a possibly marginal role

of the capacity to put thoughts and feelings into words (Bergomi et al., in press). In future studies,

researchers may investigate and compare the development of putative facets of mindfulness with


17

mindfulness meditation practice in different traditions, including secular practices such as taught in

MBSR. This may contribute to determining the aspects of the mindfulness construct that are

commonly enhanced among different mindfulness meditation practices. Moreover, empirical research

may generally profit from a phenomenological approach, which allows a more detailed account of

individual experiences related to mindfulness and meditation.

The second issue concerns the extent to which mindfulness can be subdivided into

meaningful, distinct facets. Results based on the FMI, CAMS-R and SMQ suggest that mindfulness is

intrinsically holistic with tightly interconnected aspects (Leary & Tate, 2007; Walach et al., 2006).

Alternatively, validation studies of the KIMS, FFMQ, TMS and PHLMS support that mindfulness

may be conceptualized and assessed by distinct (and stable) facets (Baer et al., 2004, 2006:

Cardaciotto et al., 2008; Lau et al., 2006). An important point needs to be resolved in this respect: do

such results depend on the nature of mindfulness, or rather on theoretical assumptions and

methodological artifacts specific to each questionnaire? The KIMS items, for instance, were

formulated based on a clear four-factor conceptualization of mindfulness (Baer et al., 2004), which

may have had a decisive influence on the factor-analytical confirmation of the expected structure.

Interestingly, in a cross-cultural study, the clear-cut KIMS factor structure reported by Baer and

colleagues (2004) could not be replicated in both an American and a Thai sample (Christopher et al.,

2009). Further studies comparing the structure of mindfulness scales between samples varying in

degree of meditation experience, cultural background, gender, and age are needed. Such studies could

shed light on the (in-)stability of putative factor structures of scales and thus provide evidence for or

against the conceptualization and measurement of mindfulness as comprising clearly distinct facets.

The third major challenge concerns whether self-report measures are a valid assessment of

mindfulness (Brown et al., 2007; Christopher et al., 2009; Grossman, 2008, 2011; Van Dam,

Earleywine & Danoff-Burg, 2009), i.e. if they provide an accurate and consistent measurement. As

mentioned previously, several studies have supported the validity of current mindfulness scales,

including expected associations with other constructs (convergent and discriminant validity) as well

as with meditation experience (known-groups validity) (Baer, Walsh & Lykins, 2009). The MAAS

was also found to predict outcomes that are consistent with mindfulness theory (predictive validity)


18

(Michalak et al., 2008). However, several authors point to a range of problems specific to the

assessment of mindfulness (Christopher et al., 2009; Grossman, 2008, 2011; Grossman & van Dam,

2011; Van Dam, Earlywine & Danoff-Burg, 2009). Grossman (2011) mentions ten putatively

intractable problems. Some of these (e.g. substantial divergence in the operationalizations of

mindfulness; content validity;the complexity and richness of mindfulness; the possibility to measure

the construct relying exclusively on negatively formulated items as in the MAAS) were already

discussed above. A number of the issues raised by Grossman challenge the validity of current

mindfulness scales and should carefully be dealt with: Are people’s ratings of their own mindfulness

biased by desires or valuations due to the personal meaningfulness of items? Does the understanding

of mindfulness items vary across different populations?The first question deals with an issue affecting

self-report assessmentin general such as bias due to social desirability and personal values.Evidence

dealing with this issue in mindfulness assessment is still scarce and inconsistent. For example, social

desirability was found to be positively correlated with the MAAS (Brown & Ryan, 2003) but

negatively correlated with the PHLMS (Cardaciotto et al., 2008). Moreover, the results were not

consistent over different social desirability scales as well as over different populations (Brown &

Ryan, 2003; Cardaciotto et al., 2008).This question, although pointing to an important issue, generally

applies to self-report assessment and it may not be specifically relevant for mindfulness. Some

unexpected results, however, suggest that a valid self-report assessment of mindfulness may be

hampered by significant differences in how scale items are understood semantically (Grossman, 2008,

2011). Several findings pointed to such differences: in a student sample, binge-drinking and smoking

students scored higher on the FMI than matched control students (Leigh et al., 2005); positive

associations of the FFMQ observe scale with measures of psychological disorders in people without

meditation experience, but not in experienced meditators, likewise suggested an idiosyncratic

understanding of certain items (Baer et al., 2006). A qualitative study by Belzer and colleagues (2011)

involving the FMI could confirm the unstable interpretation of some items. The ambiguity of words

that are typically used in mindfulness items such as ‘awareness’, ‘to notice’, ‘to judge’ or ‘experience’

may be the reason for the differences in the understanding of items (Belzer et al., 2011; Grossman,

2008). Moreover, Grossman(2011) suggested that a certain degree of mindfulness may be a


19

prerequisite for identifying own states of mindfulness (resp. mindlessness), and thus for meaningfully

responding to mindfulness items. Nevertheless, mindfulness has also been described as an inherent

human capacity that occurs naturally and is not culturally bound (Brown & Ryan, 2004; Goldstein,

2002; Kabat-Zinn, 2003). As such, it is experienced by all individuals and hence should be

measurable in individuals unacquainted with Buddhist psychology.In our view, a general rejection of

the validity of self-report scales in the measurement of mindfulness (as advocated by Grossman,

2008) seems a rather extreme response to this challenge. In fact, current criticisms of self-report

measures are based up on data derived from thecurrently available measures and are thus influenced

by the limitations of these scales.

The weaknesses of current mindfulness scales can serve to improve the operationalization of

the concept in the future. Therefore, it may be misleading to generalize from the current state of

research and conclude that mindfulness in principle cannot be assessed using self-report scales. The

challenge for the construction of self-report measures of mindfulness may thus lie with constructing

semantically clear and unambiguous items, e.g. by formulating less abstract items. This fundamental

issue should be addressed in future studies. Further qualitative examinations, evaluating item

understanding in participants with different meditation experience, age, culture or gender may

considerably contribute to the compilation of items that are uniformly interpreted across different

groups. Such studies may also point to aspects of mindfulness that cannot be meaningfully self-

evaluated by individuals who lack a certain degree of mindfulness. Uniform understanding of items

across groups should also be addressed in quantitative studies by means of differential item

functioning (DIF) analyses (Walker, 2011).

Finally, it should be noted that the act of responding to a mindfulness questionnaire itself may

exert a positive influence on the development of mindfulness. In fact, the process of self-monitoring

and self-reporting alone can produce desirable behavior change (Korotitsch & Nelson-Gray, 1999),

and this effect may be deliberately employed in mindfulness-based interventions. To our knowledge,

no study has yet dealt with this putative effect but several observations speak for its plausibility.

Favorable effects may for example result from the fact that the act of responding to questionnaire

items may remind participants of their intention to develop mindfulness. Moreover, the items may


20

provide a trigger for reflecting on which kind of experiences or emotional states facilitate or hinder

keeping a mindful attitude through the day. Feedback from participants involved in studies we are

currently conducting appear to confirm that such favorable effects occur when mindfulness is assessed

through self-report.

Conclusion

During past decades, several self-report measures of mindfulness have been validated and are

currently used in research. Each of the scales offers unique advantages and disadvantages. Together

they provide an interesting palette of instruments allowing the assessment of trait and state

mindfulness in populations with differing degrees of familiarity with mindfulness meditation,

covering a broad spectrum of aspects of mindfulness. Yet, several findings have pointed to

weaknesses of current scales, particularly with regard to the ambiguous interpretations of some items

of these scales. Moreover, there is still a lack of consensus with regard to which aspects of

mindfulness should be included in a scale and to the kind of relationships existing between them.

Further studies, as well as new assessment instruments addressing these issues, are thus encouraged.

The present overview suggested how problematic issues may be addressed. Moreover, future studies

may profit from the growing literature based on previous operationalization attempts. In general,

given the increased importance of the mindfulness concept and its widespread application in various

clinical and health-related fields, the assessment of mindfulness should be put on a more solid

theoretical and methodological basis.


21

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Table 1 Aspects of mindfulness in eight current mindfulness questionnaires

Aspect of Mindfulness (item example) Questionnaire (subscale or construct)

Observing, attending to experiences

(PHLMS 09: “When I walk outside, I am

aware of smells or how the air feels against

my face.”)

CAMS (awareness),

FMI (mindful presence, Walach et al. 2006; FMI

(mind/body awareness, Leigh et al. 2005),

KIMS (observing),

FFMQ (observe),

PHLMS (awareness)

Acting with awareness

(MAAS 10: “I do jobs or tasks

automatically, without being aware of what

I'm doing.)

MAAS (presence),

KIMS (acting with awareness),

FFMQ (actaware),

FMI (concentration, Bergomi 2007),

CAMS (attention and present-focus)

Non-judgment, acceptance of experiences

(KIMS 04: “4. I criticize myself for having

irrational or inappropriate emotions.”)

KIMS (accepting without judgment),

FFMQ (nonjudge),

SMQ (accepting difficult thoughts/images and oneself

versus judging cognitions and self).

CAMS (acceptance)

Self-acceptance

(FMI 19: “I accept myself as I am.”)

FMI (non-judgmental acceptance, Walach et al. 2006;

acceptance and openness to self and experience in Leigh

et al., 2005; self-acceptance, in Bergomi 2007)

SMQ (accepting difficult thoughts/images and oneself

versus judging cognitions and self).

Willingness and readiness to expose oneself

to experiences, non-avoidance

(PHLMS 06: “I try to stay busy to keep

thoughts or feelings from coming to mind.”)

PHLMS (acceptance)

FMI (openness to experience, Walach et al. 2006; non-

avoidant awareness, Bergomi 2007),

SMQ (allowing attention to remain with difficult


30

cognitions versus experiential avoidance)

TMS (curiosity)

CAMS (acceptance)

Non-reactivity to experience

(SMQ 1: “Usually when I have distressing

thoughts or images, I am able just to notice

them without reacting.”)

FFMQ (nonreact),

FMI (nonreactivity to inner experience, Bergomi 2007),

SMQ (letting difficult cognitions pass without reacting

versus rumination/worry)

CAMS (acceptance)

Non-identification with own experiences

(SMQ 10: “Usually when I have distressing

thoughts or images, I just notice them and

let them go.”)

TMS (decentering),

FMI(mindful presence, Walach et al. 2006; non-

attachment to thoughts,Leigh et al. 2005),

SMQ(decentered awareness).

Insightful understanding

(FMI 16: I see how I create my own

suffering.”)

FMI (insight, Walach et al. 2006),

Labeling, describing

(KIMS 2: “I’m good at finding the words to

describe my feelings.”)

KIMS (describing)

FFMQ (describe)

The nine aspects proposed here were theoretically derived on the basis of a review of current

mindfulness scales. The FMI showed an unstable factor solution over different studies. This overview

comprises all subscales of the FMI derived in three different studies in which the scale was subjected

to principal component analysis: Walach et al., 2006; Leigh et al., 2005; Bergomi, 2007

Documents

The Assessment of Mindfulness with Self-Report Measures: